Siva Narayanan, MS, MHS, director of outcomes research, Beverly Enterprises, Fort Smith, Arkansas, United States, reported data on a retrospective evaluation of 1362 newly admitted residents of nursing facilities across the United States during a recent 3-year period.

They evaluated 1 group of residents who began treatment with rivastigmine within 30 days of their AD diagnosis and were treated for at least 30 days, and another group who did not receive acetylcholinesterase inhibitor treatment.

The rivastigmine group had more verbal distress, sleep issues, sadness, loss of interest, and behavioural symptoms at baseline compared to the control group (P <.01 for each).

Overall, 8.6% of rivastigmine patients were started on antipsychotic treatment during the study compared with 17.0% of control patients. Subjects in the control group were 1.77 times more likely to take antipsychotics compared with residents in the rivastigmine group. This trend was consistent even after adjusting for age, sex, race, and the baseline presence of behavioural symptoms and mental health conditions (relative risk = 1.86; P <.001).

Residents who had baseline behavioural disturbances and those who had a mental health diagnosis were almost twice as likely to initiate antipsychotics than were those without such symptoms.

"The results substantiate prior findings of delayed use of antipsychotic drugs associated with rivastigmine relative to no cholinesterase inhibitor use in a community-based population," Mr. Narayanan said.

The findings also suggest that prior clinical research findings of behavioural benefits associated with rivastigmine may translate into reduced use of antipsychotic drugs, he added.

Finally, the finding that rivastigmine residents had more verbal distress, sleep issues, sadness, loss of interest, and behavioural symptoms at baseline compared to the control group suggests that the presence of such disturbances may be influential factors in the decision to begin AD treatment, he noted.

The study was supported by Novartis.


[Presentation title: Reduced Risk of Antipsychotic Drug Use Among Nursing Home Residents Taking Rivastigmine. Abstract P02.094]

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